Well Completion PermitHARNETT DEPARTMENT OF PUBLIC HEALTH PERMIT
TO CONSTRUCT A DRINKING WATER SUPPLY WELL
PIN #: 0546 -75- 6999.000 Parcel #: Application #: 13 -5 -31330 Subdivision:
Applicant Name: McLean Chapel Partners
Address: P.O. Box 2611 Raleigh, NC 27602
Type of Facility Served by Well: SFD
Sewage System: Pump to 25% Reduction System
Permit Conditions: Well to be drilled in Well Area
Lot #:
General Permit Conditions:
• Drinking water supply well construction must meet 15A NCAC 02C.100 rules
• The permitted drinking water supply well shall be located in accordance with the SITE PLAN
• ANY ALTERATION of the site of the site (including location of structures and appurtenance) or modification in use of the well, may
subject this Permit to revocation
Authorized State Agent Date
Grouting Inspection Witnessed Date _
[7 Grouting self - certified by driller GW -1 provided? E� Yes F-1 No
See attachment for construction sketch
Date: 6/28/2013 Application #:13 -5 -31330
WELL CERTIFICATE OF COMPLETION
Well Contractor: southern well drilling
Applicant Name: McLean Chapel Partners
Address: P.O. Box 2611 Raleigh, NC 27602
Directions to Site: 401 S to McLean Chapel lot on right
Use of Well: sfd Date Drilled: 6/19/13 Total Depth: 240 ft Replacement Well? ❑ Yes ® No
Static Water Level: 205 ft Top of Casing is 12 in. above surface. Yield: gpm at ft.
Disinfection: Type hth Amount
Water Zone (depth)
Casing
Grout
From To 205
From 0 To
150
From 0 To 20 ft
From To
Diameter:
6 in Material: pvc Thickness:
Material: portlan d Method: pour
From To
From
To
From To
Diameter:
Material: Thickness:
Material: Method:
From
To
From To
Diameter:
Material: Thickness:
Material: Method:
Inspector: bm
On Hold Date:
Release Date: 6/28/2013
Remarks:
Well Head Information
Casing Height: 12 in (above finished grade) Access Port: yes Vent Stack: yes
Well ID Tag:y_esPump ID Tag: yes Sampling Tap: yes Backflow Preventer:
Sample Taken? ❑ Yes ® No Well Head properly sealed: yes
Remarks:
C �
Authorized State Age Date
See Attachment for completion sketch
Application #:13 -5 -31330
Well Construction Sketch
Well Completion Sketch
Applicant Name: McLean Chapel Partners Subdivision: Lot #:
Well Area
\ 100 ft.
Home ❑ ❑
D Septic &
R Pump Tank
I
V
E
McLean Chapel Rd
Initial &
Repair
Septic
Drain
Fields
o Well
100 ft
Home 0 Septic
system &
repair area
McLean Chapel Rd